=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427398064
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SHARYLAND DENTAL CARE PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/19/2013
-----------------------------------------------------
Last Update Date | 02/19/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2407 E GRIFFIN PKWY
-----------------------------------------------------
City | MISSION
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78572-3301
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-581-2773
-----------------------------------------------------
Fax | 956-581-8183
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2407 E GRIFFIN PKWY
-----------------------------------------------------
City | MISSION
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78572-3301
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-581-2773
-----------------------------------------------------
Fax | 956-581-8183
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. TIMOTHY BRANN
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 956-581-2773
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number | 20855
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number | 11372
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------